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WO2012032279A1 - Surgical treatment system and method for performing an anastomosis between two hollow ducts in a patient, in particular between the bladder and the urethra - Google Patents

Surgical treatment system and method for performing an anastomosis between two hollow ducts in a patient, in particular between the bladder and the urethra

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Publication number
WO2012032279A1
WO2012032279A1 PCT/FR2011/052071 FR2011052071W WO2012032279A1 WO 2012032279 A1 WO2012032279 A1 WO 2012032279A1 FR 2011052071 W FR2011052071 W FR 2011052071W WO 2012032279 A1 WO2012032279 A1 WO 2012032279A1
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WO
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Application
Patent type
Prior art keywords
end
suture
body
free
figure
Prior art date
Application number
PCT/FR2011/052071
Other languages
French (fr)
Inventor
Arnold Ferlin
Original Assignee
Arnold Ferlin
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0643Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B17/1155Circular staplers comprising a plurality of staples
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122Clamps or clips, e.g. for the umbilical cord
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004(bio)absorbable, (bio)resorbable, resorptive
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00274Prostate operation, e.g. prostatectomy, turp, bhp treatment
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132End-to-end connections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B2017/1157Staplers for performing anastomosis in a single operation applying the staples radially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00547Prostate

Abstract

The treatment system according to the invention comprises: - suture members (20) which are made of a bioresorbable material and each of which has two legs (21, 22) having a respective free end (21A, 22A), the free ends (21A, 22A) being fixedly connectable to each other by having them interact with each other or with an attachment of the suture member in a form-fitting manner, the two legs (21, 22) being elastically deformable at least in part except for said free ends thereof; - an elongate support element (10) which can movably support the suture members and can be inserted into one of the patient's two hollow ducts (2, 3) in the direction of the central longitudinal axis of the support element (10); and - a suture member-biasing mechanism (30) that is movably supported by the support element, is disposed at least in part within the support element, and can move and deform each suture member between a retracted position in which the free ends of the two legs (21, 22) of the suture member can be moved relative to each other as they are both arranged at a radial distance from the axis which is shorter than the outer radius of the support element, and a deployed position in which the free ends of the two legs of the suture member are located outside the support element so as to be fixedly connected to each other as they are both arranged at a radial distance from the axis which is greater than the outer radius of the support element, after having transversely penetrated from the inside to the outside of the respective walls of the patient's two hollow ducts.

Description

SYSTEM AND METHOD FOR PRODUCING A SURGICAL TREATMENT ANASTOMOSIS BETWEEN PIPES HOLLOW PATIENT, PARTICULARLY

Between the bladder and urethra The present invention relates to a system and a method of surgical treatment for performing an anastomosis between two hollow conduits of a patient, such as the bladder and urethra of the patient.

The invention thus relates to the field of surgery, including urology, visceral, vascular, etc. It is for example implemented after prostatectomy of a patient, in order to surgically restore communication between the bladder neck and the terminal orifice of the urethra, opposite to the urethral meatus.

In the latter context, traditionally, surgeons perform the anastomosis between the bladder and the urethra of a patient with one or more son suture, which are implemented using a needle. This method of treatment provides good results because it helps make abutting the bank of the bladder neck and the bank of the terminal orifice of the urethra, without having to fall back on the banks themselves: we can restore an interface direct contact between the respective mucosa of the banks, which is favorable to the healing and complete and reliable recovery of the communication between the bladder and urethra. However the implementation of this application method, both a particularly important response time and great skill for surgeons, especially as the intervention area, behind the pubic bone, is particularly delicate access and the sphincter must remain intact throughout the procedure, avoiding notably its traction, perforation, its crushing, etc.

Another known technique consists in folding each of the banks on itself so as to, in some way, form an inner peripheral flange: after these two contiguous flanges, can suturing to one another by a circular series staples, implemented using a urethral catheter dedicated. EP-A-0282157 and US Patent 2009/0281560 to provide examples. However, the results of this technique are mixed, each of the banks being folded back on itself, their respective mucosa are not in contact and can not heal by "welding" naturally with each other. We understand the need to provide a large number of staples covering most or all of the periphery of the anastomosis area, these staples before moreover be metallic, or more generally non-absorbable, to guarantee the durability of the anastomosis. However, the prolonged presence of such metal staples often leads to complications in the urological field, typically calculations. That said, US-A-2008/1 14385, which can be considered as the closest prior art to the claimed invention here offers a different approach and discloses a processing system comprising a plurality of suture organs designed to be attached and attach by the interior of hollow organs to be treated. Each of these suture bodies consists of two mobile branches, which are moved from a retracted configuration, in which the free ends of the two arms are arranged at a radial distance from the central axis of a support body, which is smaller than the outer radius of the support body, to a deployed configuration wherein the free ends of the branches are driven at the outside of the body, being then located at a radial distance from said axis which is greater than the radius outside the support body so that said free ends are attached to the inner face of the walls of hollow organs to be treated. However, in the deployed above configuration, the free ends of the limbs of suture members grip the banks of two contiguous hollow conduits, by bending these banks of themselves, thereby preventing their respective mucosa to be in contact with the 'other. For the same reasons developed above, the implementation of this system therefore provides mixed results.

The purpose of the present invention to provide a system and method for performing an anastomosis between two hollow conduits, which are reliable, secure, and easy and quick to implement, while getting hold of the ducts.

To this end, the invention relates to a surgical system for performing an anastomosis, as defined in claim 1.

The invention also relates to a method of surgical treatment for performing an anastomosis, as defined in claim 19.

One of the ideas underlying the invention to seek to use suture bodies both bio-absorbable and shaped for implantation in the longitudinal direction of the urethra, each suture members overlapping the zone anastomosis between two hollow conduits of a patient, such as the urethra and the bladder neck. In this way, the respective banks of the two conduits, typically the bank of the bladder neck and the bank of the terminal orifice of the urethra, can be rendered contiguous in the tubular extension of one another, forming a direct contact interface between their respective mucosa. According to the invention, each of these suture bodies has for this purpose two specific branches: the free end of one of these branches is provided to be passed from inside outwards through the wall of a hollow conduits, while the free end of the other branch is intended to be passed from inside outwards through the wall of the other hollow conduit, then these two free ends are provided to be fixedly bonded to each other by complementary shapes either with each other or with an insert of the suture member, ie to be clipped either to each other, or both in the aforementioned insert. In practice, the opposite of their aforementioned free end, the two branches are linked by a bridge, which may be provided flexible and integral with the branches or which may allow a guided mobility of one and / or the other branches. To implement these suture bodies, the invention provides to use a supporting body, which can thus be called "holder clips": this support body is configured to be positioned and immobilized during the time deployment suture organs, inside the hollow conduits, and then to be released. In addition, to adequately deform the suture bodies to fixedly bind to each other the free ends of their branches, the invention provides a mechanism acting on each suture bodies is carried internally by the support body: this mechanism can thus advantageously be controlled within the ducts, particularly with a probe inserted from an opening of an orifice of said conduits, this probe can also be manually operated, being at least partly automated.

Advantageous additional features of the processing system according to the invention, taken individually or in all technically possible combinations, are specified in dependent claims 2 to 18.

The invention will be better understood from reading the following description given purely by way of example and with reference to the drawings:

- Figure 1 is a perspective view of a first embodiment of a processing system according to the invention;

- Figure 2 is an elevational view of a portion of the system of Figure 1;

- Figures 3 to 5 are sections respectively along the lines III-III, IV-IV and VV of Figure 2;

- Figures 6 and 7 are schematic elevational views, illustrating respectively two successive stages of use of the system of Figure 1, associated with a bladder of a patient;

- Figure 8 is a schematic elevation view partially in section of the system and of the bladder, in the step shown in Figure 7;

- Figure 9 is a schematic elevational view of the system and bladder, illustrating a step subsequent to the use of this system associated with a patient's urethra, to be anastomosed to the bladder; - Figure 10 is a schematic perspective view, partly in section, of the system, bladder and urethra illustrating a step subsequent to that shown in Figure 9;

- Figure 1 1 is a schematic elevational view, partly in section, of the system, bladder and urethra illustrating the same step as that shown in Figure

10;

- Figures 12 to 15 are views similar to Figure 1 1, respectively illustrating the successive stages of use of the system;

- Figure 16 is an elevational view of a portion of a second embodiment of a processing system according to the invention;

- Figure 17 is a section along the line XVII-XVII of Figure 16;

- Figure 18 is a perspective view of only some of the components shown in Figures 16 and 17, in a different configuration;

- Figures 19 to 23 are schematic elevational views, respectively, illustrating five successive steps of use of the system associated with FIG

16, implemented in the bladder of a patient, shown schematically in longitudinal section; and

- Figures 24 to 28 are schematic elevational views, respectively, illustrating five successive steps, subsequent to the step shown in Figure 23, with longitudinal section of the bladder and urethra to be anastomosed to the bladder.

In Figure 1 is shown a surgical system 1 for performing an anastomosis between the bladder and urethra of a patient. This system 1 mainly includes:

- a body 10 which, as detailed below, supports one or a plurality of suture elements 20 and in which is arranged a mechanism 30 for biasing the suture elements

- an applicator 40 designed to establish the body 10 when using the system 1, and

- a urethral probe 50 for, when using the system 1, to control the mechanism 30.

The applicator 40 and the probe 50 will be described later, during the detailed presentation of system usage example 1.

As shown in Figure 1 and as shown in more detail in Figures 2 to 5, the body 10 has a generally tubular shape, centered on a longitudinal axis XX. In the exemplary embodiment considered here, the body 10 comprises a cylindrical skirt 1 1 circular base centered on the axis XX. At its distal end, said skirt 1 1 is closed by a wall 12 of ogival shape. At its proximal end, skirt 1 1 is axially outward. In addition, the internal volume of skirt 1 1 communicates with the outside through a plurality of through slots 13 that extend lengthwise in the direction of the axis XX and which are distributed substantially evenly along the periphery of the skirt . In the embodiment considered in the figures, the slots 13 are six in number, as clearly visible in Figures 4 and 5. Their interest appear later.

As is clearly visible in Figure 3, each of the suture elements 20 has the overall shape of a U. More specifically, each element 20 includes two elongate legs 21 and 22 which, at their distal end, are connected fixedly to one to each other by a transverse bridge 23. This bridge 23 and connects the branches 21 and 22 of elastically deformable manner in the sense that, in the manner of a flexible hinge connection generally centered on the bridge 23, the branches 21 and 22 may be spaced apart or brought closer vis-à-vis each other, through the elastic deformation of the material constituting the element 20, without breaking the latter, which thus forms a part of a single piece.

In contrast to the bridge 23, the branches 21 and 22 respectively have free proximal ends 21A and 22A. As is clearly visible in Figure 3, the free ends 21A and 22A are shaped in substantially complementary manner to be capable of being mechanically engaged with each other and thereby secure the branches 21 and 22 one to the other at their proximal end. In the embodiment considered in the figures, the free end 22A of the leg 22 is formed as an angular notch, which extends projecting from the rest of the branch 22 towards branch 21, while end 21A of the branch 21 is formed as a notch which is delimited by recesses in the face of the end 21A, facing the leg 22 and which is dimensioned to receive snugly the end notch the branch 22. More generally, it is understood that the free ends 21A and 22A of the arms 21 and 22 have patterns in relief and / or complementary recesses, adapted to cooperate to mechanically fix the arms 21 and 22 to one each other when the ends 21A and 22A are sufficiently pressed against each other, in particular in a direction transverse to the longitudinal direction of the branches 21 and 22.

In practice, the suture elements 20 are made of a material that allows their flexible deformation, as mentioned above. Moreover, this material is selected to be bioresorbable, that is to say a material that can be resorbed in the physicochemical action of living tissues in contact with which the material is placed. By way of non-limiting example, the material of the suture elements 20 is a bioresorbable polymer such as polylactic acid (PLA, PLLA), polyglycolic acid (PGA) or polydioxanone (PDO).

Advantageously, for reasons which will become apparent hereinafter, the branch 21 has, at its distal end, an extension 21B which forms with the distal side of the bridge 23 a shoulder 24.

In the configuration of the suture elements 20 shown in Figures 1-5, the various suture elements 20, which are here six in number, are arranged substantially inside the body 10, with their legs 21 and 22 which extend lengthwise generally in the direction of the axis XX. More precisely, as clearly visible in Figures 3 and 5, the branch 22 and the bridge 23 of each member 20 are disposed entirely within the free volume of skirt 1 1, while the branch 21 is received, with a slight inclination, in one of the slots 13, emerging somewhat outside skirt 1 1 in its proximal part. When using the system 1, each suture element 20 is able to be released in all of the body 10, through one of the slots 13 generally along a radial direction to the axis XX. Advantageously, for the purpose of guiding members 20 during this passage, the width of the slots 13, that is to say the spacing between the longitudinal edges of each of these slots is substantially equal to the thickness of the branches 21 and 22: in other words, in cross section to the axis XX, the branches 21 and 22 of each member 20 have a dimension orthoradial to the axis XX substantially equal to the orthoradial spacing of slots 13, as clearly visible in Figure 5.

The mechanism 30 comprises three main parts, which are centered on the axis XX, being arranged inside the body 10 or, at least, in the axial extension of the internal volume of the body on the proximal side of this latest. These three parts are:

- a pull tab 31 which, in the example in the figures, consists of a rectilinear rod centered on the axis XX, which extends substantially over the entire length of skirt 1 1, and extending, by its A proximal end 31 outside the body 10,

- a pusher 32 which, in this example, is designed as a tube arranged coaxially around the proximal end 31A of the bar 31, and

- a guide 33 which in the example includes on the one hand, at its distal end a tubular end piece 331 which is arranged co-axially around a complementary stud 121 projecting from the wall 12 the body 10 inwardly of the body forming both a pivot connection, and, on the other hand, six disc portions 332, which, as well visible in Figure 5 are distributed substantially regularly around the axis XX, being all located in the same plane perpendicular to said axis, passing through the median region of skirt 1 1, it being specified that each of these portions 332 is rigidly connected to the distal tip 331 by a strip 333 which extends parallel to the axis X along the inner face of the skirt 1 1.

At its distal end 31B, the pull tab 31 is provided with an annular projecting head

January 31 centered on the axis XX. As is clearly visible in Figure 4, the head 31 1 shows, in cross section to the axis XX, an outer profile developed in the sense that this profile is not strictly circular; thus, this profile presents six patterns that identically repeating around the axis XX one after the other, each pattern including the one hand, a first segment 31 1 a extending in a direction orthoradial to the axis XX and, secondly, a second segment 31 1B, extending itself so as orthoradial to the axis XX but being radially farthest from the axis XX that the segment 31 1 a, it being understood that the segments 31 1 a and 31 1B are connected to each other by a cam track 31 1 C.

The bar 31 is mounted in the body 10 both in translation along the axis XX and to rotate on itself about this axis XX. In practice, a coupling bearing or a similar guide member is advantageously interposed radially between the bar 31 and the skirt 10 of the body 1 1.

The pusher 32 is, in turn, mounted on the proximal end 31A of the bar 31 in translation along the axis XX.

Furthermore, the guide 33 is mounted in the body 10 to rotate on itself about the axis XX. In the embodiment considered in the figures, the guide 33 is thus guided in rotation by the cooperation between its distal tip 331 and the pin 121 of the distal wall 12 of the body 10.

Advantageously, the guide 33 and the bar 31 are connected in rotation to each other, for reasons which will become apparent hereinafter: In the example embodiment, this rotary drive connection between the guide 33 and the pull tab 31 is made by the mechanical cooperation between the head 31 1 of the pull tab and the distal ends 333A of the webs 333, as well visible in Figure 4.

will now be described in detail a system using example 1, to achieve an anastomosis between the bladder 2 of a patient, visible in Figures 6 to 15, and urethra 3 of the patient, visible in the figures 9 to 15. typically, the aforementioned patient is treated using the system 1 after having undergone prostatectomy, typically a total vésiculoprostatectomie or radical prostatectomy.

Initially, it is considered that the body 10, the suture elements 20 and the mechanism 30 are made available to the surgeon in their relative configuration shown in Figures 1 to 5. More specifically, as clearly visible in Figure 3, each of six suture elements 20 is arranged in the body 10 so that its leg 22 runs along the bar 31, by being radially interposed between said pull tab and one of the portions 332 of the guide 33. More specifically, each of the portions 332, guide 33 defines, on its face turned towards the axis XX, a 332A surface of radial immobilisation of the branch 22, as clearly visible in Figure 5. at the same time, the branch 21 of each suture element 20 extending opposite the branch 22, with the interposition between the branches of one of the portions 332. further, in this initial configuration, the free ends 21A and 22A of the arms 21 and 22 are spaced apart from the other, that is, di re, more generally, the two free ends do not cooperate with each other. Also in this initial configuration, the head 31 1 of the bar 31 is housed in the respective shoulders 24 of the suture elements 20, with the distal extension 21B of each arm 21 substantially radially against one of the segments 31 1 A transverse profile of the head 31 1 as well visible in Figure 4.

Initially, the body 10, provided with the suture elements 20 and mechanism 30 arranged in the initial configuration detailed above, is handled by means of the applicator 40, as shown in Figure 6. For this to the proximal end 31A of the bar 31 is engaged and retained in a complementary housing 41 (Figure 1) defined at the distal end 40A of the applicator 40. Then, the applicator 40 is manipulated by the surgeon, typically as part of an endoscopic surgery or open surgery, to bring the body 10 of the bladder 2, to bring the body 10 inside the neck of the bladder 2A 2, centering the axis XX within this pass 2A and by first engaging the distal wall 12 are, as indicated by the arrow F1 in Figure 6. the shaped shoulder of the wall 12 facilitates this fitting.

Prior to the introduction of the body 10, the neck 2A of the bladder may be surgically rebuild. Indeed, at the banks of the bladder, cervix may not be ready, in the sense that it is too broad or non-circular, for example. In this case, the surgeon reshapes the neck 2A by a gesture known per se, either by means of a wire and needle, or by using the applicator 40 provided with ad hoc means, not shown in Figures of the first embodiment.

In practice, various embodiments, in particular mechanical and / or magnetic, are possible to mechanically connect the distal end 40A of the applicator 40 at the proximal end 31A of the bar 31 or, more generally, at one end proximal of the mechanism 30. in all cases, the corresponding coupling means are removable, in the sense that, via an ad hoc command transmitted by the applicator 40 from its proximal end, the mechanism 30 may be offline-vis vis the applicator 40, thereby disengage the applicator while leaving in place the body 10 inside the neck of the bladder 2 2A.

Advantageously, the body 10 is provided with mechanical means allowing to lock removably the body 10 vis-à-vis the neck 2A bladder 2. For example, as shown schematically in Figure 7, of such securing means include movable hooks 14: in the initial configuration shown in figures 1 to 5, the hooks 14 are retracted within the free volume of the body 10, particularly at the proximal end of this body, and then, after positioning the body 10 in the neck 2A bladder 2 with the aid of the applicator 40, the hooks 14 are retracted so as to be fixed, in particular by gripping or pinching the wall forming 2A the neck of the bladder 2. Advantageously, the control of the deployment of the hooks 14 is made using the applicator 40.

Of course, other embodiments that the hooks 14 are possible as regards the temporary fixing of the body 10 to the neck 2A bladder 2. In particular, according to a variant not shown, less elaborate than the movable hooks 14, the surgeon can use an attached fixing device, such as a surgical thread for example.

In a particularly preferred option, the applicator 40 is provided at its distal end 40A, of cutting elements 42, visible only in dotted lines in Figure 8. Such cutting elements 42, typically of small cutting blades or spikes bevelled, are distributed along the periphery of the distal end 40A of the applicator 40, being advantageously provided to be made to protrude from the distal end 42A toward the body 10. it is noted that the angular positioning of the cutting elements 42 is related to the angular position, around the axis XX, of the suture elements 20: when the body 10 is connected to the applicator 40, the cutting elements 42 are respectively located axially opposite a suture elements 20, in other words one of the slots 13. in this way, after having set up the body 10 into the neck of the bladder 2 2A using the applicator 40 and before releasing this has pplicateur, the cutting elements 42 are used, in particular by being deployed under the action of an ad hoc command transmitted by the applicator 40 from its proximal end for locally cutting the wall forming the neck of the bladder 2 2A, following a direction transverse to this pass and from outside this pass. In this way, the six portions of the wall 2A of the neck of the bladder 2, which are respectively located radially opposite the slots 13 and slightly inwardly against which is supported the respective branches 21 of the suture elements 20 are externally impaired under the action of the cutting elements 42. if necessary, the action of cutting elements 42 is such that said portions of the wall forming the neck 2A of the bladder 2 are perforated over substantially their entire thickness, which amounts in that the cutting elements 42 then come substantially into contact with the legs 21 of the suture elements 20, without damaging these branches.

In a second operating time after release of the applicator 40, the surgeon uses the urethral probe 50, as shown in Figure 9. In practice, the probe is inserted into the urethra meatus 3 from the latter, until an opposite end opening 3A of the urethra, visible in Figure 9. it will be understood that the terminal hole 3A due to an anterior resection of the urethra in its membrane area, carried out in particular in the context of a prostatectomy.

As is clearly visible in Figure 9, the urethral probe 50 is inserted into the urethra 3, so that its distal end 50A is located at the end opening 3A of the urethra 3. To facilitate this development instead, the distal end 50A of the probe 50 is advantageously provided with a domed cap 51 which, when the probe 50 positioned, is released by the surgeon by an ad hoc additional tool.

As an option not illustrated, before or after disengagement of the cap 51, the distal end 50A of the probe 50 can be fixed removably in the central opening 3A of the urethra 3, including means operatively or structurally similar to hooks 14 described above to temporarily immobilize the body 10 in the neck of the bladder 2A 2. if necessary, the cap 51 is internally provided with means facilitating or participating in the removable attachment.

In a subsequent surgical step, illustrated in Figures 10 and 1 1, the surgeon approximates one of the other collar 2A of the bladder 2 and the hole 3A of the urethra 3. In practice, in particular to not to damage the urethral sphincter 3, this is preferably the bladder 2 which is urged by the surgeon to bring its collar 2A 3A of the orifice of the urethra 3. in all cases, the bank of the neck bladder and the bank of the orifice of the urethra are found side by side contiguously, in the tubular extension of one another, as shown in figures 10 to 1 1. In doing so, the proximal end 31A of the bar 31 is mechanically engaged within the distal end 50A of the sensor 50: in a manner not shown in detail in the figures, the distal end 50A is shaped effect to be complementarily assembly at the proximal end 31A of the bar 31, for purposes of the mechanism control 30. in other words, the interiors of the end 50A of the probe 50 are provided to connect mechanically to the mechanism 30, so as to allow the control of the drive of this vis-à-vis the body 10. in practice mechanism, it is understood that various embodiments are conceivable in this regard as long as the probe 50 is adapted to transmit control movements of the mechanism 30 from its proximal end 50B, visible in Figure 1. Mechanical means of corresponding transmission integrated with the probe, are well known in the field of surgical instrumentation and, if necessary, the reader is referred to the relevant literature. Moreover, in the embodiment considered in FIG 1, the proximal end 50B is in the form of a manually actuated mechanism including a fixed handle 52 and a movable trigger 53. Alternatively non shown, the proximal end 50B of the probe 50 is mechanically connected to an interface connectable to a robot arm, allowing a control mechanism 30 driven by a computer under the supervision of the surgeon, typically as part of an assisted surgery computer.

Thus, returning to 10 and 1 1, we see that so far the suture elements 20 and the mechanism 30 always occupy the same initial configuration shown in Figures 1 to 5. We can describe this configuration setup retracted with regard to the suture elements 20: indeed, as explained above, the free ends 21A and 22A of the arms 21 and 22 of each suture member 20 are disposed inside the body 10 and thus to inside the neck 2A of the bladder 2, without cooperating with each other. In other words, in this configuration, the ends 21A and 22A of the arms 21 and 22 are, at most, spaced radially from the axis XX of a δ value denoted in Figure 3, which is smaller than the outside radius of the skirt 1 1 of the body 10. Note that, for visibility reasons only two of six elements 20 are shown in figures 10 and 1 1, and in figures 12 to 15 commented below.

From this retracted configuration, the surgeon control the deformation of the suture elements 20 to a first intermediate configuration, shown in Figure 12. To do this, the surgeon control, via the urethral probe 50, the drive of the zipper 51 in translation along the axis XX, facing the surgeon, that is to say facing away from the distal wall 12 of the body 10, as indicated by the arrow F2 in Figure 1 1. By axial bearing of the head 31 1 against the shoulder 24 of each suture member 20, the suture elements are driven according to a corresponding translational movement, as clearly visible from comparison of Figures 1 1 and 12, if necessary until coming axially supporting legs 22 against the pusher 32 and freely drive the translational push on the knob 31, as shown in Figure 12. at the same time, due to the axial immobility of the guide 33 within the body 10, the transverse bridge 23 of each of the suture elements 20 axially closer portions 332 of the guide 33: each of these portions 332 then forms, as it were, a wedge on between the branches 21 and 22. more specifically, while each of the spacer portions 332 radially maintained in place the branch 22, for radial support of its surface against the branch 332A, the radially opposing surface 332B forms a ramp to the branch 21, forcing the spacing of this vis-à-vis of the branch leg 22 gradually as the suture member is translated under the action of the pull tab 31. The free end 21A of the arm 21 is thus displaced transversely to the wall forming the neck 2A of the bladder 2 and passes right through this wall, from the inside outwards. The portion of each branch 21 through the wall of the neck of the bladder is facilitated by the fact that the six portions of this wall and bushings have been previously impaired by the cutting elements 42, as explained above.

Then, the surgeon control, via the urethral probe 50, the displacement of the pusher 32 in translation along the axis XX in the direction of the wall 12 of body 10, as indicated by the arrow F3 in Figure 12. The pusher 32 tends then to cause the arm 22 according to a corresponding translational movement. However, given the resistance of the head 31 1 of the bar 31, then commanded to be stationary along the axis XX, the branch 22 is deformed. More specifically, at its distal end, the pusher 32 is provided with a head 321 defining, on its distal face, a ramp surface 321 A of the branches 22. In the embodiment considered here, this ramp surface 321 A is substantially frustoconical, centered on the axis XX and converging towards the wall 12 of the body 10. for ramp effect, the head 321 of the plunger 32 deforms the leg 22 radially outwardly and radially nearer its free end 22A of branch 21, by passing through this free end 22A the wall of the terminal hole 3A of the urethra 3, from the inside outwards, as shown in Figure 13. the suture elements 20 then occupy a second intermediate configuration.

It will be noted that the deformation of branches 22, especially the trajectory of the free ends 22A, is guided through slots 54 defined in the distal end 50A of the probe 50, these slots 54 being respectively provided to extend in the extension a rectilinear slots 13 of the body 10, with suitable angular positioning between the distal end 50A of the probe 50 and the body 10 during assembly of the probe 50 to the mechanism 30, as visible in Figure 10 .

Note also that the pointed shape in the direction of the associated arm 21, the free end 22A of each arm 22 facilitates the passage of said free end through the wall delimiting the hole 3A of the urethra 3, allowing in Indeed the transverse perforation of said wall.

Thus, in their second intermediate configuration shown in Figure 13, the suture elements 20 have free ends 21A and 22A of the branches 21 and 22 disposed both outside the body 10, and the bladder 2 and urethra 3, without that these free ends of which cooperate with one another.

The surgeon will then control the engagement with each other the free ends 21A and 22A of the arms 21 and 22 of each suture element 20, to achieve that these suture elements are in said deployed configuration , shown in Figure 14. to do this, the surgeon control, via the urethral probe 50, the rotational drive of the guide 33 and the bar 31.

Thus, with regard to the guide 33, the rotation of the latter, which is indicated by the arrow F4 in Figure 5, leads to disengage in a direction orthoradial to the axis XX, each of the portions 332 of between the branches 21 and 22 of each suture member 20. in other words, via this guide rotation 33, the ramp surface 332B of each spacer portion 332 disappears othoradialement vis-à-vis the branch 21 : by elastic return, the arm 21 tends to move closer to the branch 22, by engaging its free end 21A to the free end 22A of the arm 22. Advantageously, during this elastic return branch 21, the branch 22 is held radially by the stationary 332A surface of the gap portion 332: to this end, as clearly visible in Figure 5, each spacer portion 332 is provided with a bead 334 which extends along a circumferential direction axis, the immobilization surface 332A and, in contrast, is connected to the ramp surface 332B by a recessed shoulder 335 in which the branch 21 is received. The mechanical engagement of the free end 21A with the free end 22A is so honest and reliable.

As regards the bar 31, its rotation about the axis XX, which is indicated by the arrow F5 in Figure 4, the conduit distal extension 21B of each arm 21 to follow the cam track 31 1 C the transverse profile of the head 31 1 of the zipper. In other words, each distal extension 21 is moved, by camming from the segment 31 to segment 31 1A 1B of the transverse profile of the head 31 1 thus being driven radially outward of the body 10. This displacement camming requests, each branch 21 in the manner of a lever, in that the drive radially outwardly from the distal end of each leg 21 induces a radially inward tilting of its free end 21A, promoting the mechanical engagement of said free end with the free end 22A of the branch 22. Thus, the ends 21A and 22A of the arms 21 and 22 end up spaced radially from the axis XX of a rated value Δ in Figure 14, which is greater than the outer radius ru of skirt 1 1 of body 10.

This leaves the surgeon to finish disengage entirely the suture elements 20 vis-à-vis the body 10. To this end, it controls via the urethral probe 50, the further rotation of the bar 31 and the guide 33: the axial level of the head 31 1, and the distal ends 333A of the bars 33 continue the radial clearance towards the outside of the shoulder 24 of each suture element 20, while the axial level of the spacer portions 332 , the immobilization surfaces 332A fade vis-à-vis the legs 22 which, by elastic return vis-à-vis the rest of the suture elements 20, tend to deform radially outwardly. The system 1 is then in the state shown in Figure 15, with the suture elements 20 in a released configuration vis-à-vis the body 10 and the mechanism 30. The body 10 can then be released, being evacuated through the inside of the urethra 3, drivingly with the urethral probe 50, as indicated by the arrow F6 in Figure 15.

The surgery then ends. The suture elements 20 remain in place in their deployed configuration, overlapping each anastomosis interface formed between the neck of the bladder 2 2A and 3A the terminal orifice of the urethra 3. It will be noted that, advantageously, the face of the free ends 21A of the arms 21, opposite the associated leg 22 is provided a rounded, in particular non-cutting and non-perforating, not a posteriori damaging surrounding biological tissues.

Thereafter, the suture elements 20 will gradually be resorbed after healing of the anastomosis, the quality is remarkable given the direct contact between the lining of the bladder neck and the lining of the terminal orifice of the urethra.

Various layout variants and the system 1 and the implementation method of the system are possible elsewhere. Examples:

- Rather than deforming the first branch 21 and the branch 22 of each suture element 20, the mechanism 30 may be arranged to deform the first branch 22 and branch 21;

- Instead of being controlled in rotation together, the bar 31 and the guide 33 may be controlled independently of rotation, in particular according to the surgeon's wishes;

- As an option, the system 1 includes means for locally weakening the wall of the terminal orifice of the urethra 3 3A to then facilitate the through passage for the free ends 22A of the arms 22; in practice, such weakening means are advantageously integrated into the distal end 50A of the probe and / or in the cap 51; in the presence of such weakening means, the pointed shape of the free ends 22A can then be less pronounced, or even omitted;

- As an option, the proximal end of the body 10 and the distal end of the probe 50 can be designed to cooperate directly with one another by form-locking; in this way, the mechanical connection between the body 10 and the probe 50 is enhanced and / or more stress relative positioning; for example, skirt 1 1 is on a limited portion of its periphery, extended longitudinally opposite the wall 12, to be received in a complementary notch bounded at the distal end of the probe; and or

- it is understood that the legs 21 and 22 described so far can be broadly described as semi-rigid, in the sense that they combine flexibility to deformation and stiffness necessary for their passage through the walls of the bladder and the urethra; in variants not shown, so it is conceivable that, in some portions thereof, one and / or the other of these branches may be more flexible than rigid; more generally, the branches 21 and 22 are provided deformable without breaking, for the purpose of relative movement between the retracted and deployed configurations of the suture member 20, it being noted that, if necessary, an additional workpiece can be reported to bind fixedly to each other the free ends of the branches, as will be explained just below in connection with another detailed embodiment.

In Figures 16 and 17 is shown a second embodiment of a processing system for performing an anastomosis between the bladder 2 and the urethra 3. As the system 1 described so far, the system according to this second embodiment of embodiment comprises 1020 suturing members which, as detailed below, are carried movably by a support body 1010 and are designed to be urged in displacement and deformation by a mechanism 1030 carried movably by the body of carrier 1010. As described later, when the detailed view of an example of use, the system according to this second embodiment also comprises an applicator 1040 and a probe 1050.

As is clearly visible in Figures 16 and 17, body 1010 has an elongated shape, centered on a longitudinal axis XX. In the exemplary embodiment considered here, the body 1010 mainly includes a cylindrical rod 101 1 with a circular base, centered on the axis XX.

As is clearly visible in Figures 17 and 18, each of 1020 suturing members includes four separate parts, which are assembled to each other, allowing, at least in some configurations of the suture member, a mobility between the parts. Hereinafter, three of the four above-mentioned parts will be described in more detail, assuming that each suture member 1020 is in an initial configuration vis-à-vis the support body 1010, as shown in Figures 16 and 17. thus, among the above four parts, each member 1020 includes two arms 1021 and 1022 which are connected movably via a bridge 1023 constituting a third of the above four pieces. As is clearly visible in Figures 17 and 18, the bridge 1023 has an elongated shape substantially rectilinear, extending substantially parallel to the length axis XX. Each bridge 1023 is arranged at a distal end 101 strangled 1A of the rod 101 one of the body 1010, while being radially supported in the direction of the axis XX by the end 101 1 A of the rod 101 1, while being located , along the periphery of this end 101 1 a, in the axial extension with a longitudinal slot 1013 that is defined in the main portion of the rod 101 in one opening radially on the outside of this common part, more precisely in the part distal end of said main portion, which forms a shoulder projecting radially outwardly vis-à-vis the above-mentioned distal end 101 of the rod 1 a 101 1. Each bridge 1023 has a distal longitudinal end 1023A with respect to which the proximal end 1021 B 1021 corresponding branch is articulated about a tilting axis i Zi 02 which extends substantially orthoradial manner to the axis XX. At its opposite proximal end 1023B, each bridge 1023 has a through hole or a groove, centered on a transverse axis Y1022 to the axis XX as shown in Figure 17, the main portion 1022C of the branch 1022 is slidably received in the hole defined by the proximal end 1023B of the bridge 1023, by being oriented along the axis

Advantageously, for reasons which will become apparent hereinafter, each bridge 1023 internally delimits, along the length of its main portion, a substantially straight slot 1023C, which connects the 1023A and 1023B ends, and the distal end of which is arranged the proximal end 1021 B 1021 branch articulated about the pivot axis Z 02 i. In this way, the proximal end 1021 B 1021 branch is able to be compared, in the direction of the axis XX, of the proximal end 1023B of the bridge 1023, and in operating conditions that will detailed later, it being noted that the inverse return of end 1021 B 1021 branch is prevented by non-return notches 1023B which is provided internally with the 1023C slot.

Opposite its end 1021 B 1021 each leg has a free end provided with a 1021 A piercing tip 1021 D. Advantageously, for reasons which will become apparent hereinafter, the tip 1021 D has, in its connecting region with the main portion 1021 C 1021 branch, a larger cross section than the main portion 1021 C, thereby forming a transition shoulder 1021 E.

As regards the part 1022, it has, opposite one another and connected by its main portion 1022C, a proximal end and a free end 1022B 1022A. This free end 1022A has similar arrangements to those of the free end 1021 A 1021 branch, namely a 1022D 1022nd tip and a shoulder transition with the main portion 1022C.

In the initial configuration of Figures 16 and 17, the main portion 1021 C of each branch 1021 extends lengthwise generally in the direction of the axis XX, which means that this main portion 1021 C extends substantially in the straight extension of the connecting bridge 1023. the leg 1022 has, for its part, its main part 1022C bent, the proximal segment of said main portion 1022C extending lengthwise substantially parallel to the axis XX, occupying the radial bottom of one of the slots 1013, while the distal segment of the main portion 1022C is received in the hole or groove, bounded on the proximal end 1023B of the connecting bridge 1023.

Similar to what was described for the first embodiment, the initial setup, described so far, 1020 suture bodies can be described as retracted configuration vis-à-vis the body 1010, in the sense that, in this configuration, the free ends 1021 a and 1022A 1021 branches 1022 and 1020 of each member are, at most, spaced radially from the axis XX of a δ value that is less than the maximum outer radius r 10 n of the rod 101 1 of the body 1010 as shown in Figure 17. as previously for the first embodiment, this arrangement of the suture 1020 elements allows, as explained below, to bring the cops 1010 within a inlet of the bladder 2, without interfering with the edge of this inlet port. Of course, the bladder 2 fabrics may be slightly stretched if the diameter of the bladder neck at rest is too small.

The mechanism 1030 is designed, similarly to the mechanism 30 described for the first embodiment, to displace and deform the 1020 suture organs for move from their initial retracted configuration of Figures 16 and 17, to a deployed final configuration, described thereafter. In the exemplary embodiment considered here, the mechanism 1030 includes various components that will be described hereinafter in the context of a detailed example of using the corresponding system to perform an anastomosis between the bladder 2, visible on figures 19 to 28, and urethra 3 visible in figures 24 to 28. Initially, consider that the body 1010, the suture 1020 members and mechanism 1030 are made available to the surgeon in their relative configuration shown figures 16 and 17. the body 1010 is then manipulated using the applicator 1040, as shown in Figure 19, the body 1010 is closer to the bladder 2, to introduce at least the distal end 101 1 a 1 of its stem 101 within an inlet port 2B of the bladder 2, centering the axis XX inside said inlet and first engaging there branches 1021 1020 suturing organs, as indicated by the Arrows Clover e G1 in Figure 19.

Through a command described below, the mechanism in 1030 while seeking the 1021 branches 1020 suture bodies to pass each of these branches

1020 of its substantially straight initial configuration of fig 19, a distorted U-shaped configuration shown in Figure 21, via an intermediate L-shaped configuration shown in Figure 20. To do this, the mechanism 1030 includes, for each of 1021 branches, an articulated arm 1031 that includes along its length:

- a first rectilinear segment 1031 A, whose one longitudinal end is articulated on the distal end 101 of the rod 1 A 101 1, and

- a second rectilinear segment 1031 B whose end facing the first segment 1031 is articulated on the end thereof opposite that articulated on the rod 101 1.

As is clearly visible in Figures 17 and 18, the main portion 1021 C of each 1021 branch runs along 1031 segments A and 1031 B, being removably connected to said segments so that, by tilting the 1031 B segment 90 ° relative to the 1031 segment a indicated by the arrow G2 in Figure 20, the main portion 1021 C of each 1021 branch forms an L, as shown in Figure 20, then by tilting the 1031 segment a to 90 ° the distal end 101 of the rod 1 A 101 1 indicated by the arrow G3 in Figure 21, the main portion 1021 C is U-shaped, as shown in Figure 21. In practice, given the presence of the wall of the bladder 2 bounding the inlet port 2B, the free ends 1021 of each branch A

1021 traverse from one side to the aforementioned wall of the bladder 2, transversely from the inside to the outside when the leg moves from its L-shaped in form in U. The transverse perforation of the aforementioned wall of the bladder 2 is formed by the tip 1021 D of each free end 1021 a and / or by the free end, for example bevelled to this end, the 1031 segment B. in all cases, once the tip 1021 D is the outside of the bladder, the shoulder 1021 E then precludes that the tip 1021 D passes back through the bladder wall in opposite direction. Thus, it is understood that the arm 1021 are designed to guide and constrain the 1021 branches 1020 suturing members to move these members suture between the initial configuration of Figure 19 and the intermediate configuration of Figure 21.

In practice, the arms 1031 are driven movement relative to the body 1010 by the action of ad hoc control means, via the applicator 1040. As an example, such control means comprise or consist of mechanical transmission cables, which extend from the distal end 1040A of the applicator 1040 within the stem 101 of the body 1 1010, 1031 to join the segments A and 1031 B each 1031 arms. More generally, it is expected that the distal end 1040A of the applicator 1040 is shaped to cooperate with and thereby controlling a part of the mechanism 1030, kinematically linked to the arm 1031.

Of course, it is also understood that for the 1021 branches move from their straight configuration of Figures 16 and 17 in their deformed U-shaped configuration of Figure 21, their common part 1021 C is elastically deformable or, more generally, deformable without to break up. In practice, examples of bioresorbable materials, provided above for the first embodiment, can be envisaged to realize the running part 1021 C 1021 branches, or more generally to perform all of the 1021 branches. More generally, since the 1031 arms support and guide the 1021 branches as they move throughout their implementation, we understand that these 1021 branches can present both a certain rigidity, a certain flexibility, as long they deform enough in service, without breaking.

In a particularly preferred option, the legs 1021 and mechanism 1030 are designed to allow tubulariser the bladder wall 2, through which the ends 1021 A 1021 branches have been placed. This is for example the case with the embodiment of the drive arm 1031: in fact, from the configuration of Figure 21 wherein each suture member has an overall U-shape, a kinematic dedicated gradual shift each articulated arm 1031 allows the 1021 E of the free end of each shoulder 1021 a branch 1021 to cause the aforementioned wall of the bladder 2 to give it a generally tubular shape, as in Figure 22, reconstructing easily and efficiently a collar 2A bladder 2. Concurrently, after release between the free end 1021 a of each leg 1021 and second segment 1031 B 1031 of the corresponding arm, the latter is returned to its initial position, while current portion 1021 C 1021 branch keeps its shape in L. again, it is understood that the relative tilting between the segments 1031 A and 1031 B 1031 of each arm are controlled by means ad hoc, via the applicator 1040. In a subsequent operative step, the applicator 1040 is reached as shown in Figure 23, then the surgeon uses the urethral probe 1050 as shown in Figure 24, in particular in the case of a radical prostactectomie. As described in detail above in connection with the first embodiment, the probe 1050 is introduced into the urethra from the meatus 3 of the latter, to the opposite end opening 3A of the urethra, visible in Figure 24.

The surgeon then controls, via the urethral 1050, the displacement and deformation of the prongs 1022 1020 suture organs: each of these branches 1022 moves from its initial configuration of Figures 16 and 17, to a deployed configuration shown in Figure 25 . in practice, in the embodiment considered here, each arm 1022 is biased in the displacement and deformation by a dedicated push-button 1032, two of the pushers being visible in section in Figure 17 whose movements are controlled by the probe 1050 by cooperation between the proximal end of the plunger and the distal end 1050A of the probe. Thus, each of the pushers 1032 is mounted in translation in the direction of the axis XX, being slidably received in complementary passages defined therethrough, in the direction of the axis XX of the rod 101 1, each the aforementioned passages opening, the distal end, in one of the slots 1013. by means of its displacement in translation along the direction of the axis XX, in the distal direction, under the control action of the probe 1050, each pusher 1032 results with its free end 1032A, the proximal end 1022B of the corresponding branch in 1022 according to a corresponding translational movement. However, given the resistance of the corresponding bridge 1023, then commanded to be stationary in the direction of the axis XX, the branch 1022 is deformed by ramp effect. More specifically, its main portion 1022C gradually passes through the hole or groove defined in the proximal end 1023B of the bridge 1023, forcing the longitudinal segment of said main portion 1022C, 1023B emerging from the end to be translated along the direction of the Y1022 axis, away from the shaft 101 1. Thus, the free end of each branch 1022A 1022 to translate along the axis corresponding Y1022, away from the body 1010. As is clearly visible by comparing Figures 23 and 24, this free end 1022A and passes from the inside to outside the wall delimiting the hole 3A of the urethra 3, the transverse perforation of said wall being formed by the corresponding point 1022D and / or by the free end 1032A, for example extended and terminating in a cutting edge , the corresponding pusher 1032, whereas the corresponding shoulder 1022nd then prevents 1022D advanced back through the aforesaid wall in opposite direction. Of course, on the basis of similar considerations discussed above for the running part 1021 C 1021 branches, it is understood that the current portion 1022C branches 1022 is also made of a deformable material in order to withstand without breaking his progressive bending through the end 1023B of the bridge 1023. More generally, in so far as the cooperation between the body 1010, the pushers 1032 and fixed bridges 1023 on the body 1010 support and guide the branches 1022 in their displacement at throughout their implementation, we understand that these branches in 1022 may have both a certain rigidity that flexibility, as long as they are sufficiently deformed in use, without breaking.

Thus, at this stage of the procedure, it is noted that the ends 1021 A, 1022A and 1021 branches and 1022 end up spaced radially from the axis XX of a rated value Δ in Figure 25, which is greater than the radius r ^ n outside of the skirt 101 1 body 1010. Thus, in this configuration 1020 suturing organs, branches in 1021 and 1022 each of these bodies are ready to be fixedly connected to one another by a piece reported in 1024 belonging to the member 1020, this coin 1024 being the fourth separate parts each forming member 1020, which have been mentioned above. These patches 1024 are also in place in Figure 27, while one of them is shown in Figure 18, so severed from the remainder of the suturing body 1020. However, before reporting these 1024 parts, a particularly advantageous optional aspect is implemented, as shown in Figure 26. as is clearly visible by comparing figures 25 and 26, the legs 1021 and 1022 of each suture member 1020 are moved axially from the other, thanks to the developments related to the 1023C slot described above. In practice, as has also been mentioned in connection with the first embodiment, it is preferably the bladder 2 which is required by the surgeon to bring his neck 2A of the opening 3A of the urethra 3, this approximation being accompanied by and / or controlled by the offset proximal end 1021 B 1021 branch along the slot 1023C. Under the action of non-return notches 1023D, the relative reconciliation of 1021 and 1022 branches is one way, that is irreversible: we can say that the juxtaposition between the bank joined the neck 2A of the bladder 2 and the bank 3A of the orifice of the urethra 3 is tightened in the direction of the axis XX, ie in the longitudinal direction of the urethra.

As discussed above quickly, the next surgical step consists in attaching parts 1024 as shown in Figure 27. In practice, each insert 1024 is adapted to cooperate by complementarity of shapes with both the free end 1021 a of the corresponding branch 1021 and the free end 1022A of the corresponding branch 1022, so as to be fixedly connected with these ends 1021 a and 1022A, the latter thus being connected fixedly to one another by the piece 1024. various embodiments are possible for parts 1024 as long as these various embodiments enable the clip fixedly 1021 ends a and 1022A once these ends are in the deployed configuration of figures 25 and 26. in this connection, the shoulders 1021 and 1022nd E 1021 A and 1022A ends of the branches are advantageously used to cooperate by complementarity of shapes with dedicated areas of the room 1024, in order to prevent the release of these ends once they are engaged with the workpiece 1024.

Similarly, various processing techniques can be envisaged to set up the pieces in 1024: these parts in 1024 can be individually attached by hand by the surgeon, or be carried by an ad hoc ancillary or be supported by an ancillary previously used in surgery, including the applicator 1040. in addition, when the parts are in place in 1024, may be different than that seen next to Figure 27: in fact, alternatively not shown, it may be envisaged to bring the pieces 1024 as soon as the ends 1021 A 1021 branches have passed through the wall of the bladder 2, ie from the step illustrated in Figure 21, it being understood that the ends of the legs 1022A 1022 are then clipped to parts already present in 1024 that once these ends 1022A passed through the urethra 3, that is to say from the step illustrated in Figure 25. Moreover, in the extension of this process variant, the parts 1024 can advantageously be used to form respective against restraints for branches 1021 1021 B when the tip of the latter pierces the wall of the bladder 2.

It then remains to finish the surgeon identify the suture 1020 bodies vis-à-vis the body 1010. To this end, optionally after having actuated a mechanical release control, in particular via the urethral probe 1050, the body 1010 is discharged from the interior of the urethra 3, by driving the urethral probe 1050, as indicated by the arrow G4 in Figure 27. the surgical procedure then ends, the suture 1020 bodies remaining in place in their deployed configuration which is fixed by the inserts 1024, overlapping each interface of anastomosis between the neck 2A of the bladder 2 and the terminal 3A orifice of the urethra 3, as shown in Figure 28.

Thereafter, the suture 1020 bodies will be gradually resorbed after healing of the anastomosis.

Thus, it comprises the foregoing description of the second embodiment, in connection with Figures 16 to 28, this second embodiment differs from the first embodiment in several respects, namely, inter alia, the following aspects: - rather than being integrally as the suture elements 20, the suture 1020 members each consist of four separate parts 1021, 1022, 1023 and 1024, 1020 each suture passing member, as each suture element 20, an initial retracted configuration wherein the free ends 1021 a and 1022A of the arms 1021 and 1022 are radially closer to the axis XX than is the outer surface of the body 1010, including for purposes of insertion without interference and establishment of the body within the bladder, to a deployed final configuration, wherein the free ends 1021 a and 1022A of the arms 1021 and 1022 are found fixedly related the One to the other by one of inserts 1024, the transition between the retracted and deployed configurations is performed, as with the suture elements

20, with at least local deformation and displacement of the legs 1021 and 1022;

- furthermore, thanks to the realization of the bridge 1023 as a separate part, which are movably assembled branches 1021 and 1022, the second embodiment allows a significant clamping anastomosis, this clamping can be moreover global or adaptive, that is to say, in the latter case, clamping stresses respectively applied to suture elements are unique to each organ and optionally different from each other;

- rather than all of the biasing mechanism in displacement and deformation of the suture bodies is controlled by the urethral probe, as is the case for the mechanism 30, the mechanism 1030 is controlled in part by the applicator 1040 and, for another part, the urethral probe 1050; An advantage of this aspect is that in 1021 possible branches, while the body 1010 is further mechanically connected to the applicator 1040 to temporarily immobilize the body 1010 into the bladder to be treated 2; in other words, in addition to ensuring the function branches

21, 1021 branches provide at least partially the function assigned to the hooks 14; and

- as explained above, mechanism 1030 ensures, in addition to a similar feature to that of the mechanism 30, namely biasing the move and deformation of bodies suture, a function tubularizing vis-à-vis the bladder 2, making it easy to reconstruct the neck 2A of the bladder.

Of course, various arrangements and variants to the system described with reference to Figures 16 to 28, as well as the implementation method of the system are possible elsewhere. In particular, variants of this system include that only some of the aspects differentiating vis-à-vis the first embodiment are present. Furthermore, considerations extraneous to specifications developed in this document are not restrictive to the present invention. For example, the various components of the system other than the bioresorbable suture bodies are either disposable or reusable.

Finally, although throughout the above description has been made in the context of the embodiment of an anastomosis between the bladder 2 and the urethra 3 of a patient, it is understood that the system according to the invention, and its method implementation can be more generally applied to two hollow pipes of a patient needing to be connected by anastomosis. Thus, further example of the bladder and urethra, said two hollow conduits may consist of intestinal conduits, vascular, etc.

Claims

1. - surgical processing system for performing an anastomosis between two hollow conduits (2, 3) of a patient, such as the bladder (2) and the urethra (3) of the patient, particularly after a prostatectomy, said system comprising:
- at least one suture member (20; 1020) made of a bioabsorbable material and including two legs (21, 22; 1021, 1022), which have respective free ends (21A, 22A; 1021 A, 1022A ) adapted to be fixedly bonded to each other by cooperating by complementarity of shapes either with each other or with an insert (1024) of the suture member, and that, outside of said ends free, are at least partially deformable,
- a supporting body (10; 1010) elongate, which is adapted, at a time, to carry movably the one or more suture elements (20; 1020) and to be inserted in the direction of its central longitudinal axis (XX ) in one of the two hollow conduits (2, 3) of the patient, and
- a mechanism (30; 1030) biasing the suture or members (20;
1020), which is carried movably by the support body (10; 1010), being at least arranged partly in the supporting body, and which is adapted to displace and deform the or each suture member between a configuration retracted, wherein the respective free ends (21A, 22A; 1021 a, 1022A) of the two legs (21, 22) of the suturing member are movable relative to each other, each being arranged to a radial distance (δ) of the axis (XX), which is less than the outer radius (ru) of the supporting body and a deployed configuration, wherein the respective free ends of two arms of the suture member is arranged to outside the support body to be fixedly related to one another, being each located at a radial distance (Δ) from the axis which is greater than the outer radius of the support body, after passing through transversally from the inside to the outside walls respective of the two hollow conduits (2, 3) of the patient.
2. - A system according to claim 1, characterized in that the free end (1021 A; 1022A) of one or each of the two legs (1021; 1022) of the or each suture member (1020) has, at away from the rest of the branch, a point (D 1021; 1022D), preferably able to perforate the wall of the hollow ducts (2, 3) which has advanced in its connection zone with the rest of the branch, a larger cross section than the rest of the leg so as to form a transition shoulder (1021 E; 1022nd) which is adapted to prevent disengagement of the free end of the vis-à-vis leg of said wall, and vis-à-vis the insert (1024) when said free end is engaged with the insert.
3. - A system according to one of claims 1 or 2, characterized in that the system further comprises an applicator (40; 1040) for setting up and fixing of the support body (10) in one of the conduits recesses (2, 3).
4. - System according to one of the preceding claims, characterized in that the mechanism (1030) and / or the applicator (40) are provided with means (1031 B; 1032A; 42) to weaken or perforate the wall of said hollow conduit (2, 3) in one or more portions intended to be traversed by the suture or members (20) when they move from their retracted configuration to its deployed configuration.
5. - A system according to any preceding claim, characterized in that the support body (10) is provided with means (14) removably immobilizing in one of the hollow ducts (2, 3), these immobilization means being controlled in particular by the applicator (40).
6. System according to one of claims 3 to 5, characterized in that the applicator (1040) having a distal end (1040A) shaped to cooperate with and thereby controlling at least part of the mechanism (1030), for example via at least one transmission cable.
7. - A system according to any preceding claim, characterized in that the system further comprises a probe (50; 1050) of the control mechanism (30; 1030).
8. - The system of claim 7, characterized in that the probe (50; 1050) is adapted to be inserted into one of the conduits (2, 3), in particular the urethra (3) from the meatus up the terminal port (3A) of the urethra, and has a distal end (50A; 1050A) shaped to cooperate with and thereby controlling at least part of the mechanism (30; 1030).
9. - A system according to any preceding claim, characterized in that the mechanism (30; 1030) is adapted to displace and deform the or each suture member (20; 1020) between the retracted and deployed configurations via one and then the other of two intermediate configurations, namely a first intermediate configuration in which a first (21; 1021) of two legs (21, 22; 1021, 1022) of the suture member extends through the wall of one of the hollow ducts (2, 3) of the patient with its free end (21 a; 1021 a) which is located outside of said wall and which is not fixedly linked to the free end (22A; 1022A) of the second branch (22; 1022), and a second intermediate configuration in which the second leg (22; 1022) extends through the wall of the other two hollow conduits with its free end (22A; 1022A) which is located outside this you wall and which is not fixedly attached to the free end (21 A; 1021 A) of the first limb (21; 1021).
10. - A system according to claim 9, characterized in that the mechanism (30) comprises:
- a pull tab (31) which, relative to the holder body (10) is mounted in translation along the longitudinal axis (XX) and which is adapted for driving in translation the or each suture member (20) for the pass from its retracted configuration to its first intermediate configuration;
- a pusher (32) which is mounted for translation along the axis (XX) relative to the pull tab (31) and which is adapted to deform, in particular by ramp effect, the second part (22) of the or each suture member (20) to pass this suture member from its first intermediate configuration to its second intermediate configuration, and
- a guide (33) which is fixedly connected to the support body (10) along the axis (XX) and that, for the or each suture member (20) includes a spacer portion (332) interposed between the two branches (21, 22) of the suture member and defining both a ramp surface (332B) for the first leg (21) and a radial stop surface (332A) to the second branch (22) so that, by translation (F2) of the pull tab (31), the free end (21A) of the first leg (21) deviates in a substantially radial direction to the axis, vis-à screw the free end (22A) of the second branch (22) when the suture member moves from its retracted configuration to its first intermediate configuration and then by opposite translation (F3) of the tappet (32), the end free (22A) of the second leg (22) approaches, in a substantially radial direction to the axis, vis-à-vis the free end (21A) of the first branch (21) when the suture member moves from its first intermediate configuration to its second intermediate configuration.
January 1. - System according to claim 10, characterized in that the guide (33) is mounted rotatably about the axis (XX) relative to the support body (10) and is adapted to, while the or each suture member (20) is in its second intermediate configuration, being driven in rotation on itself so as to disengage in a direction orthoradial to the axis, the spacer portion (332) of the two legs (21, 22 ) of the suture member to move the suture member in its expanded configuration.
12. - The system of claim 1 1, characterized in that, for the or each suture member (20), the spacing portion (332) of the guide (33) is provided with a heel (334), which extends along a circumferential direction to the axis (XX), the radial stop surface (332A) to the second leg (22) and which is connected to the ramp surface (332B) by a shoulder recess (335) wherein the first leg (21) is received by spring back to mechanically engage the free end (21A) of the first branch with the free end (22A) of the second branch (22).
13.- A system according to any of claims 10 to 12, characterized in that the pull tab (31) is rotatably mounted about the axis (XX) relative to the support body (10) and is adapted to, while the or each suture member (20) moves from its second intermediate configuration to its deployed configuration, to move radially outwardly of the support body, by camming action, the end (21B) of the first leg ( 21) of the suture member, opposite to its free end (21 A).
14. - A system according to claim 9, characterized in that the mechanism (1030) comprises:
- for each suture member (1020), an arm (1031) which is pivotably mounted on the support body (1010) and along at least a portion of which the first limb extends (1021) of the member a suture (1020) so that the arm and forced displacement guide in this first branch for passing the suture member from its retracted configuration to its first intermediate configuration; and
- at least a pusher (1032), which is mounted for translation along the axis (XX) relative to the support body (1010) and which is adapted to act on the second leg (1022) of the suture or members ( 1020) and the force to deform relative to the rest of the suture member, in particular by ramp effect, to pass each suture member from its first intermediate configuration to its second intermediate configuration.
15. - A system according to any of claims 9 to 14, characterized in that the first leg (1021) of the or each suture member (1020) extends along a part of the mechanism (1030), in particular along two segments (1031 a, 1031 B) that includes the arm (1031) and which are articulated to one another, so that, in particular by relative tilting of said two segments, the first branch of the suture member in its first intermediate configuration successively presents an overall U-shape and an overall L-shaped tubulariser to the wall of the hollow conduit (2) through which the first leg extends.
16. - A system according to any preceding claim, characterized in that the or each suture member (1020) further includes a bridge (1023) of movable connection between the two legs (1021, 1022), bridge which one and / or the other of the two branches are connected movably, in particular bridge which the first leg (1021) of the suture member is assembled in a movable manner, the first part being moved relative to the bridge when the suture member moves from its retracted configuration to its first intermediate configuration, and / or bridge to which the second leg (1022) of the suture member is movably joined, the second part being displaceable relative to the bridge when the suture member moves from its first intermediate configuration to its second intermediate configuration.
17. - A system according to claim 16, characterized in that the bridge (1023) is provided with means (1023C, 1023D) of axial approach of the two legs (1021, 1022) of the or each suture member (1020), these approximation means being adapted for, when the suturing device is in its deployed configuration, axially guide towards one another the two legs, especially where they pass through the walls of the ducts, while retaining both branches one vis-à-vis the other to prevent them diverge axially to clamp the anastomosis between the conduits.
18. - A system according to any of claims 1 to 15, characterized in that the two legs (21, 22) of the or each suture member (20) are opposite to their free end (21 A , 22A) connected permanently to one another elastically deformable manner so that the suture member forms a suture member (20), in particular integrally.
19. - Surgical treatment method for performing an anastomosis between two hollow conduits of a patient, such as the bladder and urethra of the patient, particularly after a prostatectomy method in which:
- providing at least one suture member, made of a bio-absorbable material and including two arms which have respective free ends adapted to be relied fixedly to each other by cooperating complementary forms or the with each other or with an insert of the suture member,
- it also has an elongate support body which movably carries the suture or bodies,
- is introduced into one of the patient's hollow conduits the support body in the direction of its central longitudinal axis so that the or each suture member is in a retracted configuration, in which the free ends of the two branches of the suture member are movable relative to one another, being each arranged at a radial distance from the axis which is less than the outer radius of the support body, and
- mechanically biases the or each suture member so as to deform and move it from its retracted configuration to a deployed configuration, wherein the respective free ends of the two branches of the suturing member are disposed outside the body carrier to be fixedly related to one another, being each located at a radial distance from the axis which is greater than the outer radius of the supporting body, after said free ends have crossed transversely from the inside to outside the respective walls of the two hollow conduits of the patient.
PCT/FR2011/052071 2010-09-09 2011-09-09 Surgical treatment system and method for performing an anastomosis between two hollow ducts in a patient, in particular between the bladder and the urethra WO2012032279A1 (en)

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FR1057157A FR2964553B1 (en) 2010-09-09 2010-09-09 Surgical treatment system for performing an anastomosis between the bladder and the urethra

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US13821601 US9211117B2 (en) 2010-09-09 2011-09-09 Surgical treatment system and method for performing an anastomosis between two hollow ducts in a patient, in particular between the bladder and the urethra
EP20110773060 EP2613717B1 (en) 2010-09-09 2011-09-09 Surgical treatment system for performing an anastomosis between two hollow ducts in a patient, in particular between the bladder and the urethra

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FR2964553A1 (en) 2012-03-16 application
US9211117B2 (en) 2015-12-15 grant
EP2613717A1 (en) 2013-07-17 application
US20130267968A1 (en) 2013-10-10 application
FR2964553B1 (en) 2012-08-31 grant
EP2613717B1 (en) 2014-11-05 grant

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